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Medicaid Enrollment: June 2013 Data Snapshot

Appendix B: Adult Expansions

Prior to the ACA, states could not receive federal Medicaid matching funds to cover non-disabled childless adults. As such, states could only cover these adults if they obtained a waiver or through a fully state-funded program. Effective April 2010, the ACA gave states flexibility to expand Medicaid to adults to get an early start on the 2014 expansion. Since April 2010, seven states (CA, CT, CO, DC, MN, NJ, and WA) have expanded coverage to adults through the new ACA option or a waiver to prepare for 2014. However, overall, Medicaid coverage for low-income adults remains very limited. As of January 2013, only nine states, including DC, provided full Medicaid coverage to low-income adults, and enrollment is closed in two of these states. Sixteen states only provide limited coverage to adults, and enrollment is closed in eight of these states. (Figure 17)

Figure 17: Coverage of Low-Income Adults by Scope of Coverage, January 2013

Figure 17: Coverage of Low-Income Adults by Scope of Coverage, January 2013

In the table on the following page (Table B-1), 17 states were able to report separately enrollment data for childless adults for June 2013; an additional five states reported data that included both parents and childless adults. Of the 2.6 million low-income non-disabled adults covered under expansion programs in these states in June 2013, at least 1.86 million were childless adults. Enrollment in June 2013 was positively affected by continued rollouts of adult expansions in California, Colorado, and Louisiana. In terms of percentage change, four other states (Connecticut, Maryland, Iowa, and Michigan1) saw double digit enrollment growth.

In contrast, eleven states reported enrollment declines between June 2012 and June 2013. Enrollment in most of these states for this group was negatively affected by enrollment freezes or enrollment caps either newly instituted or in place in a number of states, most notably in Arizona, where 40,800 fewer childless adults remained enrolled in June 2013 compared to one year earlier.2 Maine and Wisconsin also saw enrollment declines of 25 percent or more, both of which had long-standing enrollment caps for their childless adult waiver programs. Additionally, Wisconsin added premiums to its waiver programs in July 2012.

Coverage for childless adults will markedly change in January 2014. Twenty-six states, including 21 states that currently cover childless adults, plan move forward with the Medicaid expansion in 2014. 3  Eight states (ID, IN, LA, ME, MO, OK, UT, and WI) with current Section 1115 waivers to cover childless adults have indicated that they are not moving forward with the ACA Medicaid expansion in 2014. However, CMS recently approved one-year waiver extensions in 5 of these states (ID, IN, LA, MO, and OK.)4 In these states, the waiver coverage will continue, but coverage will be limited to individuals with incomes below 100% FPL and will not be eligible for the enhanced Medicaid financing available under the ACA. Current Medicaid beneficiaries with incomes above 100% FPL will be eligible for help purchasing coverage in the new Marketplaces. Wisconsin has a waiver proposal would reduce eligibility for childless adults in its existing waiver program to 100% FPL. Maine plans to let their current Section 1115 waiver for childless adults expire, resulting in childless adults covered under the waivers losing eligibility and likely becoming uninsured.

Table B-1: Adult Expansions June 2011 to June 2013 (Monthly Enrollment in Thousands)
State
June 2011
June 2012
June 2013
June 2011 to June 2012
June 2012 to June 2013
Childless adults
Arizona *
224.5
116.4
75.7
-48.1%
-35.0%
Colorado
N/A
7.8
14.8
N/A
90.5%
Connecticut
72.0
79.3
91.2
10.1%
15.0%
DC **
39.2
42.9
45.3
9.3%
5.8%
Delaware
37.1
40.6
41.2
9.6%
1.4%
Indiana
16.1
15.2
12.6
-5.8%
-17.2%
Maine
16.5
13.2
9.0
-20.2%
-31.5%
Maryland
56.8
66.7
79.6
17.4%
19.2%
Massachusetts
114.7
123.4
121.0
7.5%
-1.9%
Michigan
77.9
38.1
79.5
-51.1%
108.7%
Minnesota **
83.9
83.0
87.7
-1.1%
5.6%
New Jersey****
N/A
47.9
41.7
N/A
-13.0%
New Mexico ******
26.5
24.5
24.3
-7.6%
-0.6%
New York *****
949.3
991.7
1,046.7
4.5%
5.5%
Oregon
49.5
48.5
42.5
-2.0%
-12.5%
Vermont
NR
34.4
33.7
NR
-1.9%
Wisconsin
34.2
24.3
17.8
-28.9%
-26.8%
Subtotal (Childless adults only)
1798.3
1797.8
1864.1
-0.02%
3.69%
Parents and Childless Adults
California
184.2
449.7
611.1
144.1%
35.9%
Iowa
46.0
56.3
65.2
22.3%
15.8%
Louisiana *****
20.5
50.7
60.8
148.0%
19.9%
Utah **** 16.8 16.7 15.5 -0.3% -7.3%
Washington

37.9

32.9

27.6

-13.2%

-16.1%

Subtotal (Parents and Childless adults
305.4 606.3 780.2
98.5%
28.7%
Total (Both Groups)
2103.6
2404.1
2644.3
14.3%
10.0%

NOTES: There are four additional states that cover childless adults with Title XIX funds that are not included in the table above: Arkansas (premium assistance only), Hawaii, Idaho (premium assistance only), and Oklahoma (premium assistance only.) Enrollment data for childless adults were not included in reports for AR, ID, and OK. Hawaii’s total enrollment data includes this group, but did not break this group out from other enrollees. Additionally, there are county-based expansions in Missouri (St. Louis area), Illinois (Cook County) and Ohio (Cuyahoga County) that were not included in the data reported.
NR – The state did not report enrollment for this group for this period.
N/A – The state did not cover such individuals during this period.
*Arizona data reported here reflect corrections for additional individuals erroneously excluded in prior reporting. Total figures for the state have also been corrected as well.
**Data for these states (DC and MN) reflect childless adults covered under state plan options, but do not reflect childless adults covered under an 1115 waivers (though they are reported in total figures.)
***New Jersey data reported here reflects enrollment among childless adults covered under the state’s 1115 waiver granted April 2011; data do not reflect enrollment in FamilyCare, which is funded with both Title XIX and Title XXI funds.
****Utah data reported here reflect enrollment in their Primary Care waiver program, which covers both parents and childless adults; previous reports had erroneously categorized this as childless adults previously.
*****Louisiana has an approved 1115 waiver to establish the Greater New Orleans Community Health Connection (GNOCHC) program. The program serves non-elderly adults in the New Orleans area with incomes under 200% FPL.
****** Estimates of the share of childless adults covered under Section 1115 waiver programs in these states (NM and NY) are reported here.
SOURCE: Compiled by Health Management Associates from state Medicaid enrollment reports for KCMU.

Appendix A: Table A-6: Aged and Disabled Enrollees